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Abdominal vascular injury

What's new

The European Society for Vascular Surgery (ESVS) has released new guidelines for the management of vascular trauma, including abdmonial vascular injury. For blunt minor injuries to the abdominal aorta, iliac, renal, or superior mesenteric arteries (ESVS grade 1) without ongoing bleeding, nonoperative management with surveillance and antithrombotic therapy is recommended. For patients in shock with ongoing bleeding, immediate surgical exploration and hemorrhage control should be performed. Endovascular stent graft repair is suggested for hemodynamically stable patients with external contour abnormalities, such as pseudoaneurysms (ESVS grade 2). Open surgical repair is the first-line treatment for blunt or penetrating abdominal aortic injury with free hemorrhage and hemodynamic instability (ESVS grade 3). Synthetic graft material is recommended for aortic reconstruction in emergency situations, even in the presence of concomitant bowel injury. .

Background

Overview

Definition
Abdominal vascular injury refers to any trauma to the major blood vessels in the abdomen, which can lead to potential life-threatening hemorrhage.
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Pathophysiology
Abdominal vascular injury typically results from trauma or iatrogenic causes, such as surgical procedures. The injury can lead to disruption of the vessel wall, resulting in bleeding and potential organ ischemia due to loss of blood supply.
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Epidemiology
The prevalence of abdominal vascular injury is particularly high in trauma patients, especially in instances of motor vehicle accidents, falls from height, or interpersonal violence.
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Disease course
The clinical manifestations of abdominal vascular injury can be acute or delayed. Acute symptoms include hypotension and abdominal pain, which can be indicative of ongoing bleeding. Delayed symptoms may include anemia due to chronic blood loss or an abdominal bruit, which can suggest the presence of a vascular injury.
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Prognosis and risk of recurrence
The mortality and morbidity rates associated with this injury are high due to the potential for life-threatening hemorrhage.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of abdominal vascular injury are prepared by our editorial team based on guidelines from the European Society for Vascular Surgery (ESVS 2025), the Eastern Association for the Surgery of Trauma (EAST/WTA/PTS 2023), the Pan-European Multidisciplinary Task Force for Advanced Bleeding Care in Trauma (ABC-T 2023,2019), the American Heart Association (AHA/ACC 2022), ...
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